Measles

Measles signs and symptoms appear around 10 to 14 days after exposure to the virus. Signs and symptoms of measles typically include:

• Fever
• Dry cough
• Runny nose
• Sore throat
• Inflamed eyes (conjunctivitis)
• Tiny white spots with bluish-white centers on a red background found inside the mouth on the inner lining of the cheek — also called Koplik's spots
• A skin rash made up of large, flat blotches that often flow into one another

The infection occurs in a sequence of stages during a period of two to three weeks.

• Infection and incubation. For the first 10 to 14 days after you're infected, the measles virus incubates. You have no signs or symptoms of measles during this time.
• Nonspecific signs and symptoms. Measles typically begins with a mild to moderate fever, often accompanied by a persistent cough, runny nose, inflamed eyes (conjunctivitis) and sore throat. This relatively mild illness may last two or three days.
• Acute illness and rash. The rash consists of small red spots, some of which are slightly raised. Spots and bumps in tight clusters give the skin a splotchy red appearance. The face breaks out first.

Over the next few days, the rash spreads down the arms and trunk, then over the thighs, lower legs and feet. At the same time, the fever rises sharply, often as high as 104 to 105.8 F (40 to 41 C). The measles rash gradually recedes, fading first from the face and last from the thighs and feet.

• Communicable period. A person with measles can spread the virus to others for about eight days, starting four days before the rash appears and ending when the rash has been present for four days.

Measles is a highly contagious illness caused by a virus that replicates in the nose and throat of an infected child or adult. Then, when someone with measles coughs, sneezes or talks, infected droplets spray into the air, where other people can inhale them.

The infected droplets may also land on a surface, where they remain active and contagious for several hours. You can contract the virus by putting your fingers in your mouth or nose or rubbing your eyes after touching the infected surface.

About 90% of susceptible people who are exposed to someone with the virus will be infected.

Risk factors:

Risk factors for measles include:

• Being unvaccinated. If you haven't received the vaccine for measles, you're much more likely to develop the disease.
• Traveling internationally. If you travel to developing countries, where measles is more common, you're at higher risk of catching the disease.
• Having a vitamin A deficiency. If you don't have enough vitamin A in your diet, you're more likely to have more-severe symptoms and complications.

Your doctor can usually diagnose measles based on the disease's characteristic rash as well as a small, bluish-white spot on a bright red background — Koplik's spot — on the inside lining of the cheek. However, many doctors have never seen measles, and the rash can be confused with a number of other illnesses. If necessary, a blood test can confirm whether the rash is truly measles. The measles virus can also be confirmed with a test that generally uses a throat swab or urine sample.

There's no specific treatment for an established measles infection. However, some measures can be taken to protect vulnerable individuals who have been exposed to the virus.

• Post-exposure vaccination. Nonimmunized people, including infants, may be given the measles vaccination within 72 hours of exposure to the measles virus to provide protection against the disease. If measles still develops, the illness usually has milder symptoms and lasts for a shorter time.
• Immune serum globulin. Pregnant women, infants and people with weakened immune systems who are exposed to the virus may receive an injection of proteins (antibodies) called immune serum globulin. When given within six days of exposure to the virus, these antibodies can prevent measles or make symptoms less severe.

Medications:

• Fever reducers. You or your child may also take over-the-counter medications such as acetaminophen (Tylenol, others), ibuprofen (Advil, Children's Motrin, others) or naproxen sodium (Aleve) to help relieve the fever that accompanies measles.

Don't give aspirin to children or teenagers who have measles symptoms. Though aspirin is approved for use in children older than age 3, children and teenagers recovering from chickenpox or flu-like symptoms should never take aspirin. This is because aspirin has been linked to Reye's syndrome, a rare but potentially life-threatening condition, in such children.

• Antibiotics. If a bacterial infection, such as pneumonia or an ear infection, develops while you or your child has measles, your doctor may prescribe an antibiotic.
• Vitamin A. Children with low levels of vitamin A are more likely to have a more severe case of measles. Giving vitamin A may lessen the severity of the measles. It's generally given as a large dose of 200,000 international units (IU) for children older than a year.